A0621 - Temporal Analysis of Medicare Physician Reimbursement for Common Gastroenterology Procedures From 2007 to 2022

Mihir Khunte, BS¹, Nhu Dang, BA¹, Anthony Zhong, BA², Soryan Kumar, BS¹, Kendra Kamp, PhD, RN³, Brad Conway, BA, JD⁴, Samir A. Shah, MD, FACG^5
1Warren Alpert Medical School of Brown University, Providence, RI; ²University of Ottowa, Ottowa, ON, Canada; ³University of Washington, Seattle, WA; ⁴American College of Gastroenterology, Bethesda, MD; ⁵Warren Alpert Medical School / The Miriam Hospital, Providence, RI

Introduction: As the U.S. population ages, gastroenterologists will provide care for an increasing number of older patients – many of whom use Medicare. In recent years there have been significant policy changes surrounding Medicare reimbursement for physicians. Understanding reimbursement trends can help reveal the financial impact of these policies on gastroenterologists. Our study aims to analyze the trends in Medicare reimbursement of common gastrointestinal (GI) services from 2007 to 2022.

Methods: The top ten GI procedures and their respective CPT codes were identified through a joint list published by the American College of Gastroenterology, American Society of Gastrointestinal Endoscopy, and American Gastroenterological Association. The top 5 five CPT codes relating to office/inpatient visits provided by gastroenterologists to Medicare Part B beneficiaries was identified using data from CMS. The Physician Fee Schedule Look-Up Tool from CMS was queried for the selected CPT codes from 2007 to 2022, to determine the facility reimbursement rate by Medicare for each service. The reimbursement data were adjusted to January 2022 U.S. dollars using the U.S. Department of Labor’s Bureau of Labor Statistics’ consumer price index inflation calculator.

Results: The unadjusted physician reimbursement for GI procedures exhibited an average decrease of 7.0% (95% CI, -9.9% to -4.1%) from 2007 to 2022. After adjusting for inflation, the mean decrease in physician reimbursement for procedures was 33.0% (95% CI, -35.1% to -30.9%). The mean annual growth rate in reimbursement was -2.6% (95% CI, -2.8% to -2.4%). The unadjusted physician reimbursement for inpatient and outpatient visits exhibited an average increase of 32.1% (95% CI, 4.8% to 59.3%). After adjusting for inflation, physician reimbursement for patient visits exhibited a mean decrease of 4.92%.

Discussion: The analysis revealed a steady decline in adjusted and non-adjusted reimbursement between 2007 and 2022. Decreasing Medicare reimbursement may impact health outcomes, healthcare access, and patient satisfaction. Reimbursement policies must be scrutinized particularly in the light of high inflation and increased costs due to additional costs associated with care during the COVID-19 pandemic, staffing shortages, and increased staffing salaries.




Disclosures:


Mihir Khunte, BS¹, Nhu Dang, BA¹, Anthony Zhong, BA², Soryan Kumar, BS¹, Kendra Kamp, PhD, RN³, Brad Conway, BA, JD⁴, Samir A. Shah, MD, FACG⁵. A0621 - Temporal Analysis of Medicare Physician Reimbursement for Common Gastroenterology Procedures From 2007 to 2022, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.